Mutilation is not the key

Male circumcision and its correlation with HIV infection rates received a great deal of media attention following the International AIDS Conference in Toronto in August. Celebrities Bill Clinton, Stephen Lewis, and Bill and Melinda Gates announced what they said was a “promising prevention strategy” for combating HIV in Africa: male circumcision.

Lewis, UN special envoy on AIDS in Africa, even described how he and a local African leader “bonded” over their respective circumcisions.

On the heels of the International AIDS Conference, I attended the 9th International Symposium on Circumcision, Genital Integrity, and Human Rights in Seattle, Aug 24-26.

“Is preemptive removal of healthy functioning tissue from millions of newborns justifiable on the grounds that decades later, some men might be protected from infection?” asked Leonard Glick, a physician, professor of anthropology and author of Marked In Your Flesh: Circumcision From Ancient Judea To Modern America. “The result of HIV research in the US provides all the information we need to understand that circumcision does not prevent HIV infection.

“England, France, Italy, Germany, Sweden and most other European nations have infant circumcision rates around one percent and HIV prevalence rates far below those of the USA,” he continued. “The evidence all points in one direction; circumcision has not prevented HIV infection.”

Dr James L Snyder, urologist and past president of the Virginia Urological Society, displayed numerous gut-wrenching photos of American children with severe genital damage from routine infant circumcisions. One of these patients, whose penis was completely destroyed, is now a young man. Snyder described him as “very angry.”

Botched circumcisions are even more frequent in Africa than in the Western World with a reported 21 related deaths since June in South Africa alone. But casualties never factor into the specious claims of those who promote circumcision.

When I asked for Snyder’s reaction to the studies touting evidence of a correlation between HIV/AIDS infection and circumcision he was forthcoming with his views.

“Beginning about 1946 we reared a generation in which 90 percent of the sexually active men were circumcised. When the AIDS epidemic began, the United States had prepared in a fashion which we now are planning to export to the world: mass circumcision of male children. If only this had been effective, we would not have close to one million people now infected with the HIV/AIDS virus in the United States. This disease infected the circumcised and the intact alike. The lesson must be learned that the AIDS virus is not caused by, or transmitted by, the presence of natural, normal body parts, but by the transmission of infected semen and blood from an infected person to sexual partners, regardless of circumcision status.

“The reports emerging from Africa that circumcision prevents AIDS/HIV infection are not scientific experiments with appropriate controls and quantifiable stimulus or burdens of infectious material,” Snyder continued. “They are observations of random behavior and exposure to infection from which no scientific conclusions can be made. They are, at best, anecdotal reports based on wishful thinking by those with a vested interest in perpetuating circumcision.

“Mr Gates and Mr Clinton would be more effective in this epidemic if they confined their efforts to education and development of effective immunization or treatment, and forgot about circumcision.”

The psychosexual dynamic remains the same whether circumcisions happen in North America or Africa. Those, on whom circumcision has been imposed, perpetuate it by imposing it on others. In America, this compulsion to make baby look like daddy is the same one that pushes circumcised young men to gang up and inflict circumcision on their intact peers in South Africa. I dare say this is the same motivation behind the prominent personalities who promoted circumcision at the AIDS conference.

“The attempt to show a correlation between circumcision status and HIV infection is nothing new,” said Jacqueline Sonnendrucker, a retired RN and longtime advocate of genital integrity for all children. “In 1986 Aaron Fink, a doctor of questionable ethics, called for universal neonatal circumcision, proposing that circumcision was a ‘natural condom,’ and therefore a prophylactic against HIV/AIDS.”

Considering that some of the African studies now claim circumcision is 60 percent effective in reducing the risk of HIV transmission, Sonnendrucker asked, “Who wants a condom that is 60 percent effective?”

Following the scheduled presentations, attendees at the circumcision symposium met to discuss the study papers presented at the AIDS conference and Clinton, Lewis, and the Gates’ announcement. Most felt strongly that circumcision programs in Africa would only generate a false sense of security that would, in turn, undermine effective and proven methods of HIV prevention, like education.

Ken McGrath, a pathology professor at Auckland University of Technology, criticized the Auvert study, widely cited to support circumcision as prevention for AIDS in Africa.

“It does not meet the minimal requirements established in the Bradford-Hill criteria,” he said. (The Bradford-Hill criteria are widely used to determine the association between a disease and a supposed causative agent. They are used as a way of determining if a specific factor, like smoking, causes a disease, like cancer.)

“There is no causal link between HIV prevalence and circumcision,” said McGrath.

Many attendees at the circumcision symposium felt the celebrity endorsements of circumcision at the AIDS conference might even help to hasten circumcision’s decline. With growing global awareness of the human rights issues associated with genital cutting of children, several countries appear close to amending their laws to protect all children, male, female, and intersexed from genital mutilation.

“Thailand, Senegal, and Eastern Uganda have been successful in stopping the spread of HIV/AIDS,” said Marilyn Fayre Milos, RN, executive director of the National Organization of Circumcision Information Resource Centers and coordinator of the International Symposia on Circumcision, Genital Integrity, and Human Rights. “With aggressive educational efforts about the threat of HIV/AIDS, the importance of safe sex practices, and the essential need for condom use, HIV/AIDS can be eradicated without the inherent risks of circumcision. Education, not amputation, is the wise and effective course of action.”